MEDICARE: INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QR0400X	Rehabilitation Clinic/Center
3	261QP2000X	Physical Therapy Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK9205	OTHER	GA	RAILROAD MEDICARE GROUP PROVIDER #

General Provider Information

NPI Number	:	1912950569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	2230 TOWNE LAKE PKWY
Second Line	:	BUILDING 1200, SUITES 100 & 110
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5540
Country	:	US
Telephone Number	:	770-926-2744
Fax Number	:	770-926-2794

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TROY BAGE
Credential	:
Telephone Number	:	423-238-7217

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/25/2010

Similar Medicare Providers

1033108121 — DR. ROMUALDA S KLICIUS MD
Practice Location Address:

2230 TOWNE LAKE PKWY , BUILDING 300, SUITE 100
WOODSTOCK, GA
30189-5540

Practice Phone: 770-517-1900
Practice Fax: 770-926-3215

1750361697 — NAYYER U ISLAM MD
Practice Location Address:

2230 TOWNE LAKE PARKWAY , BLDG, NO. 900, SUITE 250 & 150
WOODSTOCK, GA
30189-5540

Practice Phone: 404-556-9222
Practice Fax: 404-556-9222

1548216203 — WELLSTAR KENNESTONE OB/GYN, LLC
Practice Location Address:

2230 TOWNE LAKE PKWY , BUILDING 500, SUITE 100
WOODSTOCK, GA
30189-5540

Practice Phone: 678-445-5941
Practice Fax: 678-445-5950

1194771766 — VINCENT MICHAEL MAGLIOCCO O.D.
Practice Location Address:

2230 TOWNE LAKE PKWY , BUILDING 700 SUITE 100
WOODSTOCK, GA
30189-5540

Practice Phone: 770-591-3511
Practice Fax: 770-591-3752

1710933924 — WALTER FRANK PORTER III MPT
Practice Location Address:

2230 TOWNE LAKE PKWY , BUILDING 1200, SUITES 100 & 110
WOODSTOCK, GA
30189-5540

Practice Phone: 770-926-2744
Practice Fax: 770-926-2794

1437106218 — WELLSTAR TOWNE LAKE PEDIATRICS, LLC
Practice Location Address:

2230 TOWNE LAKE PKWY , BUILDING 300, SUITE 100
WOODSTOCK, GA
30189-5540

Practice Phone: 770-517-1900
Practice Fax: 770-926-3215

Directions to “INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.